Provider Demographics
NPI:1699971838
Name:MEACHEM, RAVONDA CARNEY (MS)
Entity type:Individual
Prefix:MS
First Name:RAVONDA
Middle Name:CARNEY
Last Name:MEACHEM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 DILLARD ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-3022
Mailing Address - Country:US
Mailing Address - Phone:336-707-6517
Mailing Address - Fax:336-294-7657
Practice Address - Street 1:907 DILLARD ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-3022
Practice Address - Country:US
Practice Address - Phone:336-707-6517
Practice Address - Fax:336-294-7657
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-816320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities